tetano
Editor, Senior Moderator
Ann Emerg Med
. 2020 Dec 17;S0196-0644(20)31455-4.
doi: 10.1016/j.annemergmed.2020.12.007. Online ahead of print.
Diagnosed and Undiagnosed COVID-19 in US Emergency Department Health Care Personnel: A Cross-sectional Analysis
Nicholas M Mohr[SUP] 1 [/SUP], Karisa K Harland[SUP] 2 [/SUP], Anusha Krishnadasan[SUP] 3 [/SUP], Patrick Ten Eyck[SUP] 4 [/SUP], William R Mower[SUP] 5 [/SUP], James Willey[SUP] 6 [/SUP], Makini Chisolm-Straker[SUP] 7 [/SUP], Stephen C Lim[SUP] 8 [/SUP], L Clifford McDonald[SUP] 9 [/SUP], Preeta K Kutty[SUP] 9 [/SUP], Elisabeth Hesse[SUP] 10 [/SUP], Scott Santibanez[SUP] 10 [/SUP], David A Talan[SUP] 11 [/SUP], Project COVERED Emergency Department Network
Affiliations
Abstract
Study objective: We determine the percentage of diagnosed and undiagnosed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among a sample of US emergency department (ED) health care personnel before July 2020.
Methods: This was a cross-sectional analysis of ED health care personnel in 20 geographically diverse university-affiliated EDs from May 13, to July 8, 2020, including case counts of prior laboratory-confirmed coronavirus disease 2019 (COVID-19) diagnoses among all ED health care personnel, and then point-in-time serology (with confirmatory testing) and reverse transcriptase-polymerase chain reaction testing in a sample of volunteers without a previous COVID-19 diagnosis. Health care staff were categorized as clinical (physicians, advanced practice providers, and nurses) and nonclinical (clerks, social workers, and case managers). Previously undiagnosed infection was based on positive SARS-CoV-2 serology or reverse transcriptase-polymerase chain reaction result among health care personnel without prior diagnosis.
Results: Diagnosed COVID-19 occurred in 2.8% of health care personnel (193/6,788), and the prevalence was similar for nonclinical and clinical staff (3.8% versus 2.7%; odds ratio 1.5; 95% confidence interval 0.7 to 3.2). Among 1,606 health care personnel without previously diagnosed COVID-19, 29 (1.8%) had evidence of current or past SARS-CoV-2 infection. Most (62%; 18/29) who were seropositive did not think they had been infected, 76% (19/25) recalled COVID-19-compatible symptoms, and 89% (17/19) continued to work while symptomatic. Accounting for both diagnosed and undiagnosed infections, 4.6% (95% confidence interval 2.8% to 7.5%) of ED health care personnel were estimated to have been infected with SARS-CoV-2, with 38% of those infections undiagnosed.
Conclusion: In late spring and early summer 2020, the estimated prevalence of severe acute respiratory syndrome coronavirus 2 infection was 4.6%, and greater than one third of infections were undiagnosed. Undiagnosed SARS-CoV-2 infection may pose substantial risk for transmission to other staff and patients.
. 2020 Dec 17;S0196-0644(20)31455-4.
doi: 10.1016/j.annemergmed.2020.12.007. Online ahead of print.
Diagnosed and Undiagnosed COVID-19 in US Emergency Department Health Care Personnel: A Cross-sectional Analysis
Nicholas M Mohr[SUP] 1 [/SUP], Karisa K Harland[SUP] 2 [/SUP], Anusha Krishnadasan[SUP] 3 [/SUP], Patrick Ten Eyck[SUP] 4 [/SUP], William R Mower[SUP] 5 [/SUP], James Willey[SUP] 6 [/SUP], Makini Chisolm-Straker[SUP] 7 [/SUP], Stephen C Lim[SUP] 8 [/SUP], L Clifford McDonald[SUP] 9 [/SUP], Preeta K Kutty[SUP] 9 [/SUP], Elisabeth Hesse[SUP] 10 [/SUP], Scott Santibanez[SUP] 10 [/SUP], David A Talan[SUP] 11 [/SUP], Project COVERED Emergency Department Network
Affiliations
- PMID: 33771413
- DOI: 10.1016/j.annemergmed.2020.12.007
Abstract
Study objective: We determine the percentage of diagnosed and undiagnosed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among a sample of US emergency department (ED) health care personnel before July 2020.
Methods: This was a cross-sectional analysis of ED health care personnel in 20 geographically diverse university-affiliated EDs from May 13, to July 8, 2020, including case counts of prior laboratory-confirmed coronavirus disease 2019 (COVID-19) diagnoses among all ED health care personnel, and then point-in-time serology (with confirmatory testing) and reverse transcriptase-polymerase chain reaction testing in a sample of volunteers without a previous COVID-19 diagnosis. Health care staff were categorized as clinical (physicians, advanced practice providers, and nurses) and nonclinical (clerks, social workers, and case managers). Previously undiagnosed infection was based on positive SARS-CoV-2 serology or reverse transcriptase-polymerase chain reaction result among health care personnel without prior diagnosis.
Results: Diagnosed COVID-19 occurred in 2.8% of health care personnel (193/6,788), and the prevalence was similar for nonclinical and clinical staff (3.8% versus 2.7%; odds ratio 1.5; 95% confidence interval 0.7 to 3.2). Among 1,606 health care personnel without previously diagnosed COVID-19, 29 (1.8%) had evidence of current or past SARS-CoV-2 infection. Most (62%; 18/29) who were seropositive did not think they had been infected, 76% (19/25) recalled COVID-19-compatible symptoms, and 89% (17/19) continued to work while symptomatic. Accounting for both diagnosed and undiagnosed infections, 4.6% (95% confidence interval 2.8% to 7.5%) of ED health care personnel were estimated to have been infected with SARS-CoV-2, with 38% of those infections undiagnosed.
Conclusion: In late spring and early summer 2020, the estimated prevalence of severe acute respiratory syndrome coronavirus 2 infection was 4.6%, and greater than one third of infections were undiagnosed. Undiagnosed SARS-CoV-2 infection may pose substantial risk for transmission to other staff and patients.